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| David L. Neuburger, M.D. |
Dr. David L. Neuburger has a few distinct memories of the New York City neighborhood of his early childhood. He remembers the green newspaper stands with stacks of the day’s papers bundled up. He recalls the ubiquitous corner phone booths (where Clark Kent sometimes morphed into Superman). He remembers that after his school was destroyed in a deliberately-set fire he was bussed to Harlem for first grade. He remembers carrying a dime in his pocket in case he got lost and had to rely on one of these phone booths to call home. He remembers his phone number: “Wadsworth 7, 4437.”
The interview: It is during the early months of the Covid-19 pandemic and it is a warm June day. We are sitting in the wide backyard of Dave’s log home on ten wooded acres bordering a branch of the meandering Codorus Creek in Southern York County. We are, of course, carefully sitting at least fifteen feet apart. We had talked about doing this by Zoom or such, but Dave thought this setting would be safe enough, and much nicer. The freshly-mowed grass, the tall mature trees, and the lovely songbirds were a welcome delight.
So a relaxed Dr. Neuburger sat on a bench, stretched his legs out, and told his story.
He was born in 1953 in Manhattan and spent his early years in the immigrant-rich culturally-diverse but sometimes scary Upper West Side (recall the ground-breaking 1957 show “West Side Story”). His parents were refugees who fled the anti-Semitism and violence of Nazi Germany as children. They didn’t talk about this when Dave was young, and he didn’t experience anti-Semitism himself as a child. Their harrowing stories, including the untimely death of his paternal grandfather, a well-respected member of the small Battenberg community, after he was taken into “protective custody” by the local police would not be allowed to intrude into Dave’s childhood, and he only learned the details much later.
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| West Side Story: The rival Sharks and the Jets from the 1961 movie (IMBD) |
As we talked, I found out that Dr. Neuburger’s path to becoming a physician was not exactly a straight line.
I will try to trace it. He was a Boy Scout, but dropped out “when that got old.” Well, his two buddies planned to go into medicine and that influenced him. So in his senior year of high school, he joined a medical Explorer Post based at a local hospital. While, yes, medicine might be “a better fit“ as a career he, instead, had envisioned life as a field research biologist, “leaning towards large animal biology.”
But federal funding for such research was being cut off. So he talked with someone from International Paper about “managing a forest for wildlife.” They were only interested in “cutting down trees.”
Anyway, even though field job prospects were slim Dave still wanted to attend Cornell to study forestry. He applied there, and to MIT, on a whim, as his so-called “reach” school. When the principal called him down to his office one day (“What did I do wrong?” Dave instantly thought) and informed Dave that he was accepted at MIT there was no real question; he would go to Boston, “a cool city.”
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| The MIT Dome at dusk (from Frontiers) |
During the summer of his sophomore year, as he thought about what to do, he volunteered at Peter Bent Brigham as a transporter. He then took a gross anatomy course (with cadaver) in conjunction with Harvard. He was “fascinated by the whole thing” and he was “struck by the engineering aspects about how the human body works.”
So medicine, it turns out, had a certain allure. Dr. Neuburger describes himself as “a people person” and he likes an intellectual challenge. And he had specific ideas about how he wanted to live (“in the country,” he said). A life in medicine could satisfy those needs. And he thought it would be “fun getting to know families.”
While living in Boston he dated a girl from Harrisburg and she told him about Hershey Medical School. Family Medicine became a boarded specialty in 1969, and in the mid-1970s Hershey was positioning itself as a training center for primary care/family physicians for all of Pennsylvania. Dave was interested.
He worked hard and graduated from MIT a semester early. He had six months before starting the grind of medical school and he wanted to spend it traveling. So he bought an old Dodge van and converted it into a camper, and he and his boyhood buddy Mark (who lived two houses away and who now studies sediment cores from freshwater lakes) decided to explore Central America.
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| Map of Central America (from Lighthouse Magazine) |
The road trip through Mexico, Belize, British Honduras, Guatemala, and El Salvadore was “transformative.” He saw that “there was a world outside of the U.S.” He saw people “living in very poor conditions” and that they were “happy, kind, and honest.” He saw that “you didn’t need material things to get by in life.” And he saw that “people who have the most don’t tend to be happier.” But he also saw dead bodies cast by the side of the road due to the civil war in Guatemala, and he looked down into the crater of Pacaya, an active steaming volcano. The six-month trip was “eye-opening.”
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| Steam billowing from the Pacaya volcano |
(The two intrepid travelers sometimes went to a local police station to ask where they might safely camp for the night. The police offered them “protective custody” as they were told it would be best for them to park the van there.)
While he was traveling Dave tried to stay in touch with his girlfriend from Pennsylvania (she wanted to join him on the trip but the timing wasn’t right), but mobile phones were not yet available. And while he was gone (to find himself) “she met someone else.”
Anyway, Dave entered medical school in 1975. He had been promised that he would be assigned to a family and that he would follow it closely for the four years he was at Hershey. But that program was dropped because it “interfered with the academics.” He was disappointed. He settled into his studies. He was let down again when things changed and he could no longer follow his Family Practice patients after they were admitted to the hospital.
He met his future wife, Marilyn, in 1976. She was the childhood friend of his roommate from college, Bill. Dave was the Best Man at Bill’s wedding on Long Island. Marilyn was there, and they hit it off. She was a speech therapist and when she took a summer job in the Poconos, Dave valiantly offered to drive her the four hours from Long Island to the camp so she didn’t have to take the bus. They kept in touch as she did her Masters in speech pathology in Illinois. Things worked out and they began living together in 1977.
After medical school, Dr. Neuburger decided to do his family practice residency in Harrisburg and he and Marilyn lived on one farm, and then another. They decided to marry in 1980. He generally enjoyed his post-graduate training.
During his residency, he did a few rotations at the York Hospital and he liked what he saw. He liked the feeling of the well-trained specialty staff and he liked that as a primary care physician you could admit your own patients, even to the ICU and CCU, and take care of them through their acute illnesses. And he liked that the relationship with the internists and specialists was seen as a partnership, contrary to what he sensed while with Hershey. And he liked the setting; that you could live “in the country.”
So he joined the practice of Drs. Dale Kresge and Mike Dobish, Dallastown Medical Associates. He enjoyed his practice, and as he saw many of his patients every three months they often became “like extended-family.” The gratification was in getting to know his patients as individuals, “not numbers.” These relationships over the years were very important to him.
Dr. Neuburger felt that he could handle 95% of the problems that came through the office. And he became good at “recognizing that something that looked like it was one thing was really something else” so he would not hesitate to refer the patient to a consultant who knew a bit more.
In the era of specialization, what is the role of the family doctor? According to the AAFP:
The focus in clinical primary care medicine in the 21st century is, we have been repeatedly told, on the patient. It is said to be patient-centered rather than disease-oriented. And the patient is a person, someone with a history. As Dr. Eric Cassell wrote:
Anyway, when my husband and I bumped into Dave and his wife one day while he was hiking with close friends around Lake Williams I asked him if he would let me interview him; he quickly said yes. Marilyn walked behind, with my husband, and she wondered if I had written any stories about the pain of legal actions against doctors. She felt that it was important to talk about such things. So I cautiously asked Dr. Neuburger if he would mind telling me his painful story; he said he didn’t.
Late in his career, he was accused of failing to diagnose a patient’s cancer in a timely manner. The legal suit was brought a year later and went to court two years after that. It was “one of the worst experiences” of Dave’s life. The jury found him “not liable” as he had followed the relevant guidelines and shared his thinking and decision-making with the patient. Relieved, he broke down and "sobbed."
But the terrible emotional trauma was not over. There were several groundless appeals that dragged on over the next two years. These were denied. And it was over. But the finality was, in a sense, anticlimactic. Dave said that there must be a better way of handling such things.
I wondered if this experience changed the way he practiced? Did he become more defensive? No. Did he order more diagnostic tests? No.
But as the practice of medicine itself changed over the decades it became more and more difficult for Dr. Neuburger to find the joy. When he started out, he said, wryly, “You could write for any branded medicine and order any test you wanted! Anything you wanted to do, you could just do it! We were kind of like doctors then.” But now, we have “other people second-guessing everything,” mostly to save money for the insurer. New bureaucratic changes introduced every few years made doctoring increasingly cumbersome as they pulled him away from what he thought was best for his patient.
“Why and how did that happen?” I asked.
Big-business saw how much money there was to be made in the world of medicine. The insurance industry, the large pharmaceutical companies, the medical device firms, and the number-crunchers in the big hospital systems saw the piles of money for the taking. Dave told me that the number of bureaucrats went up dramatically as the number of physicians inched up only slightly (as their influence went down).
While he was traveling Dave tried to stay in touch with his girlfriend from Pennsylvania (she wanted to join him on the trip but the timing wasn’t right), but mobile phones were not yet available. And while he was gone (to find himself) “she met someone else.”
Anyway, Dave entered medical school in 1975. He had been promised that he would be assigned to a family and that he would follow it closely for the four years he was at Hershey. But that program was dropped because it “interfered with the academics.” He was disappointed. He settled into his studies. He was let down again when things changed and he could no longer follow his Family Practice patients after they were admitted to the hospital.
He met his future wife, Marilyn, in 1976. She was the childhood friend of his roommate from college, Bill. Dave was the Best Man at Bill’s wedding on Long Island. Marilyn was there, and they hit it off. She was a speech therapist and when she took a summer job in the Poconos, Dave valiantly offered to drive her the four hours from Long Island to the camp so she didn’t have to take the bus. They kept in touch as she did her Masters in speech pathology in Illinois. Things worked out and they began living together in 1977.
After medical school, Dr. Neuburger decided to do his family practice residency in Harrisburg and he and Marilyn lived on one farm, and then another. They decided to marry in 1980. He generally enjoyed his post-graduate training.
During his residency, he did a few rotations at the York Hospital and he liked what he saw. He liked the feeling of the well-trained specialty staff and he liked that as a primary care physician you could admit your own patients, even to the ICU and CCU, and take care of them through their acute illnesses. And he liked that the relationship with the internists and specialists was seen as a partnership, contrary to what he sensed while with Hershey. And he liked the setting; that you could live “in the country.”
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| Dale Kresge, M.D. |
Dr. Neuburger felt that he could handle 95% of the problems that came through the office. And he became good at “recognizing that something that looked like it was one thing was really something else” so he would not hesitate to refer the patient to a consultant who knew a bit more.
In the era of specialization, what is the role of the family doctor? According to the AAFP:
“Family physicians are personal care doctors for all people of all ages and health conditions. They are reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system, and set health goals.“
The focus in clinical primary care medicine in the 21st century is, we have been repeatedly told, on the patient. It is said to be patient-centered rather than disease-oriented. And the patient is a person, someone with a history. As Dr. Eric Cassell wrote:
“Knowledge of persons is particularly important today because what most clearly distinguishes chronic disease [the bulk of primary practice] from acute disease is that it takes place over a long enough period of time so that the nature of the person has an undeniable influence on the unfolding narrative of the disease, and the disease influences the further development of the person.”And Dave is, as he already told me, and as I can clearly see, is definitely “a people person” and someone who tries to see the long view.
Anyway, when my husband and I bumped into Dave and his wife one day while he was hiking with close friends around Lake Williams I asked him if he would let me interview him; he quickly said yes. Marilyn walked behind, with my husband, and she wondered if I had written any stories about the pain of legal actions against doctors. She felt that it was important to talk about such things. So I cautiously asked Dr. Neuburger if he would mind telling me his painful story; he said he didn’t.
Late in his career, he was accused of failing to diagnose a patient’s cancer in a timely manner. The legal suit was brought a year later and went to court two years after that. It was “one of the worst experiences” of Dave’s life. The jury found him “not liable” as he had followed the relevant guidelines and shared his thinking and decision-making with the patient. Relieved, he broke down and "sobbed."
But the terrible emotional trauma was not over. There were several groundless appeals that dragged on over the next two years. These were denied. And it was over. But the finality was, in a sense, anticlimactic. Dave said that there must be a better way of handling such things.
I wondered if this experience changed the way he practiced? Did he become more defensive? No. Did he order more diagnostic tests? No.
But as the practice of medicine itself changed over the decades it became more and more difficult for Dr. Neuburger to find the joy. When he started out, he said, wryly, “You could write for any branded medicine and order any test you wanted! Anything you wanted to do, you could just do it! We were kind of like doctors then.” But now, we have “other people second-guessing everything,” mostly to save money for the insurer. New bureaucratic changes introduced every few years made doctoring increasingly cumbersome as they pulled him away from what he thought was best for his patient.
“Why and how did that happen?” I asked.
Big-business saw how much money there was to be made in the world of medicine. The insurance industry, the large pharmaceutical companies, the medical device firms, and the number-crunchers in the big hospital systems saw the piles of money for the taking. Dave told me that the number of bureaucrats went up dramatically as the number of physicians inched up only slightly (as their influence went down).
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| Striking growth in the number of administrators over 40 years (Bureau of Labor Statistics) |
So Dr. Neuburger retired in 2015 after 32 years in practice. Though he was “the tech guy” in the office, and was even asked by his partners to pick out which electronic health record to use, computerized notes were not his thing. He saw that this would change the personality of the intimate medical encounter between patient and physician. He didn’t like what he saw coming, and since he “didn’t want to be a complainer” he left medicine early.
How does he spend his time now? He has more time for family, he enjoys his lovely backyard, he cuts down trees and clears brush, he fashions beautiful wood furniture, he raises honey bees, he is a bow-hunter, he rides his bike (sometimes “pretty fast”) on the nearby rail-trail and elsewhere, and he loves hiking and backpacking through wilderness areas with his wife and their friends. How serious is the back-packing thing? How about hiking the entire state of Oregon on the Pacific Crest Trail, all 455 miles, for starters? (I’m exhausted and feeling blisters on my feet just listening to that.)
How does he spend his time now? He has more time for family, he enjoys his lovely backyard, he cuts down trees and clears brush, he fashions beautiful wood furniture, he raises honey bees, he is a bow-hunter, he rides his bike (sometimes “pretty fast”) on the nearby rail-trail and elsewhere, and he loves hiking and backpacking through wilderness areas with his wife and their friends. How serious is the back-packing thing? How about hiking the entire state of Oregon on the Pacific Crest Trail, all 455 miles, for starters? (I’m exhausted and feeling blisters on my feet just listening to that.)
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| Back-packer Dave posing for a photo on the Pacific Crest Trail |
He is proud of the service he has given to the York County Farm & Natural Lands Trust, including several years as president. This non-profit organization is, according to their mission, “dedicated to preservation of the finest agricultural and environmental landscapes for future generations to enjoy.”
Did I say that he studied literature at MIT? Dave said that he greatly appreciates Mark Twain and has a few first editions of his works.
What about Dr. Neuburger’s biological family?
His son and daughter are married. After fleeing the early phase of the pandemic in New York City, son Mark and his wife Heather, a psychologist, now live in White Plains, New York. Taking after his dad, Mark completed a through-hike of the 2,190-mile (!) Appalachian Trail eight years ago with his buddy, Dane Jensen, and is a self-employed software developer. Daughter Becky and her husband, Darren, an accountant, live nearby in York Township. Becky is a behavioral specialist consultant. Their eight-month-old son, Jon, is the light of "Grandpa" Dave's life.
Dave's parents are “comfortable” and in their 90s. His father was trained as a mechanical engineer. He worked for Raymond Lester & Associates, the famous model-building firm that created the precise 1:1200 scale model of New York City for the 1964 World’s Fair (Dave said he could even pick out the apartment where they lived when he was a kid). His mother was a teacher. His brother Jon is a film editor for PBS who has done shows for American Experience, Nova, and Frontline. And his brother Dan works for Lockheed-Martin, but he is forbidden to tell Dave what he actually does.
Did I say that he studied literature at MIT? Dave said that he greatly appreciates Mark Twain and has a few first editions of his works.
What about Dr. Neuburger’s biological family?
His son and daughter are married. After fleeing the early phase of the pandemic in New York City, son Mark and his wife Heather, a psychologist, now live in White Plains, New York. Taking after his dad, Mark completed a through-hike of the 2,190-mile (!) Appalachian Trail eight years ago with his buddy, Dane Jensen, and is a self-employed software developer. Daughter Becky and her husband, Darren, an accountant, live nearby in York Township. Becky is a behavioral specialist consultant. Their eight-month-old son, Jon, is the light of "Grandpa" Dave's life.
Dave's parents are “comfortable” and in their 90s. His father was trained as a mechanical engineer. He worked for Raymond Lester & Associates, the famous model-building firm that created the precise 1:1200 scale model of New York City for the 1964 World’s Fair (Dave said he could even pick out the apartment where they lived when he was a kid). His mother was a teacher. His brother Jon is a film editor for PBS who has done shows for American Experience, Nova, and Frontline. And his brother Dan works for Lockheed-Martin, but he is forbidden to tell Dave what he actually does.
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| 1964 World's Fair New York City Panorama (from the Queens Museum; still on exhibit) |
At the end of the pleasant nearly two-hour interview, Dr. Neuburger guided me and my husband around his property. He pointed out the large wooded area that he had cleared by hand. He showed us his three beehives with buzzing worker bees doing their thing. He pointed to dried dung on the ground that he quickly identified as from a fox.
And as we walked under the green leafy canopy I was reminded of “forest bathing,” the Japanese practice termed Shinrin-Yoku; the meditative process of “taking in the forest atmosphere through all of our senses.” This simple “exposure to nature and green environments” has been shown to lower heart rate and blood pressure, to reduce stress hormone production, to boost the immune system, and to improve overall feelings of well-being.
So, as Dr. Neuburger knows, there are recognized benefits of playing in, living in, and simply being in nature, or “in the country.”
Reference:
Cassell, Eric J. Doctoring: The Nature of Primary Care Medicine. New York: Oxford University Press, 1997.
Reading:
Twain, Mark, (Samuel L. Clemens) ."The turning point in my life" in What is Man? New York and London: Harper and Brothers, MCMXXIV. ( https://www.google.com/books/edition/What_is_Man/qv0QAAAAMAAJ?hl=en&gbpv=1)
by Anita Cherry 8/1/20
And as we walked under the green leafy canopy I was reminded of “forest bathing,” the Japanese practice termed Shinrin-Yoku; the meditative process of “taking in the forest atmosphere through all of our senses.” This simple “exposure to nature and green environments” has been shown to lower heart rate and blood pressure, to reduce stress hormone production, to boost the immune system, and to improve overall feelings of well-being.
So, as Dr. Neuburger knows, there are recognized benefits of playing in, living in, and simply being in nature, or “in the country.”
Reference:
Cassell, Eric J. Doctoring: The Nature of Primary Care Medicine. New York: Oxford University Press, 1997.
Reading:
Twain, Mark, (Samuel L. Clemens) ."The turning point in my life" in What is Man? New York and London: Harper and Brothers, MCMXXIV. ( https://www.google.com/books/edition/What_is_Man/qv0QAAAAMAAJ?hl=en&gbpv=1)
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| Dave's leafy backyard the day of the interview |
by Anita Cherry 8/1/20
